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Pediatric Bipolar Disorder: Subtype Trend and Impact of Behavioral Comorbidities
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Frontotemporal White Matter in Adolescents with, and at-Risk for, Bipolar Disorder

Circadian Phase Preference in Pediatric Bipolar Disorder

PediMIND Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, RI 02915, USA
Chronobiology and Sleep Program at E.P. Bradley Hospital and the Alpert Medical School, Brown University, Providence, RI 02915, USA
Centre for Sleep Research, University of South Australia, Adelaide 5005, Australia
Author to whom correspondence should be addressed.
J. Clin. Med. 2014, 3(1), 255-266;
Received: 10 December 2013 / Revised: 11 February 2014 / Accepted: 19 February 2014 / Published: 11 March 2014
(This article belongs to the Special Issue Bipolar Disorder in Children and Adolescents)
Pediatric bipolar disorder (BD) rates have notably increased over the past three decades. Given the significant morbidity and mortality associated with BD, efforts are needed to identify factors useful in earlier detection to help address this serious public health concern. Sleep is particularly important to consider given the sequelae of disrupted sleep on normative functioning and that sleep is included in diagnostic criteria for both Major Depressive and Manic Episodes. Here, we examine one component of sleep—i.e., circadian phase preference with the behavioral construct of morningness/eveningness (M/E). In comparing 30 BD and 45 typically developing control (TDC) participants, ages 7–17 years, on the Morningness-Eveningness Scale for Children (MESC), no between-group differences emerged. Similar results were found when comparing three groups (BD−ADHD; BD+ADHD; TDC). Consistent with data available on circadian phase preference in adults with BD, however, we found that BD adolescents, ages 13 years and older, endorsed significantly greater eveningness compared to their TDC peers. While the current findings are limited by reliance on subjective report and the high-rate of comorbid ADHD among the BD group, this finding that BD teens demonstrate an exaggerated shift towards eveningness than would be developmentally expected is important. Future studies should compare the circadian rhythms across the lifespan for individuals diagnosed with BD, as well as identify the point at which BD youth part ways with their healthy peers in terms of phase preference. In addition, given our BD sample was overall euthymic, it may be that M/E is more state vs. trait specific in latency age youth. Further work would benefit from assessing circadian functioning using a combination of rating forms and laboratory-based measures. Improved understanding of sleep in BD may identify behavioral targets for inclusion in prevention and intervention protocols. View Full-Text
Keywords: child; adolescent; bipolar disorder; circadian child; adolescent; bipolar disorder; circadian
MDPI and ACS Style

Kim, K.L.; Weissman, A.B.; Puzia, M.E.; Cushman, G.K.; Seymour, K.E.; Wegbreit, E.; Carskadon, M.A.; Dickstein, D.P. Circadian Phase Preference in Pediatric Bipolar Disorder. J. Clin. Med. 2014, 3, 255-266.

AMA Style

Kim KL, Weissman AB, Puzia ME, Cushman GK, Seymour KE, Wegbreit E, Carskadon MA, Dickstein DP. Circadian Phase Preference in Pediatric Bipolar Disorder. Journal of Clinical Medicine. 2014; 3(1):255-266.

Chicago/Turabian Style

Kim, Kerri L., Alexandra B. Weissman, Megan E. Puzia, Grace K. Cushman, Karen E. Seymour, Ezra Wegbreit, Mary A. Carskadon, and Daniel P. Dickstein. 2014. "Circadian Phase Preference in Pediatric Bipolar Disorder" Journal of Clinical Medicine 3, no. 1: 255-266.

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